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Microneedling: consent (page 2)

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Please provide consent at the bottom of this page.

I confirm that the medical history and medication details that I have supplied are complete and correct and that there is no other medical information I need to disclose.

I understand that withholding any medical information may be detrimental to my health and safety during the treatment in which l agree to undertake.

If there is any change in my medical history, it is my responsibility to advise the practitioner before further treatments are carried out.

I understand that there are certain contraindications that would preclude me from receiving treatment including an active bacterial, viral, fungal, or herpetic infection, raised moles or warts, active acne, rosacea, facial cancers, history of radiation therapy within the application area, a history of abnormal scarring, keloids, atrophic skin, autoimmune disorders, haemophiliac, diabetes, taking anticoagulants, pregnant or breastfeeding.

I confirm that I understand the risks and conditions associated with the treatment. These have been fully explained to me and l have had the opportunity to ask any questions and these have been answered to my satisfaction. Development of any reactions must be reported to the practitioner as soon as possible.

I accept and understand that there are no written, implied, or verbal guarantees as to the anticipated results of this treatment and that the effects of treatment will vary with some patients than with others and that the goal of this treatment is improvement, not perfection.

I may require a series of treatments, normally with at least 3-6 weeks between procedures, to achieve the maximum cosmetic result.

I have been given post treatment advice and I understand and agree to follow all the care instructions carefully to minimise the risk of side effects

I confirm that I have been allowed sufficient time to make a carefully considered decision.

I consent to the taking of (pre and post-treatment) photographs to monitor treatment effects. Complete patient confidentiality will be maintained at all times.

I, the above named, confirm that I understand the risks and conditions associatd with this treatmewnt and am aware that is an elective medical-cosmetic treatment, and have read the information provided below.